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Current Evidence on the Effect of Pre-Orthodontic Trainer in the Early Treatment of Malocclusion

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Current Evidence on the Effect of Pre-Orthodontic Trainer in the Early Treatment of Malocclusion IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 18, Issue 4 Ser. 17 (April. 2019), PP 22-28 www.iosrjournals.org Current Evidence on the Effect of Pre-orthodontic Trainer in the Early Treatment of Malocclusion Dr. Shreya C. Nagda1, Dr. Uma B. Dixit2 1Post-graduate student, Department of Pedodontics and Preventive Dentistry, DY Patil University – School of Dentistry, Navi Mumbai, India 2Professor and Head,Department of Pedodontics and Preventive Dentistry, DY Patil University – School of Dentistry, Navi Mumbai, India Corresponding Author: Dr. Shreya C. Nagda Abstract:Malocclusion poses a great burden worldwide. Persistent oral habits bring about alteration in the activity of orofacial muscles. Non-nutritive sucking habits are shown to cause anterior open bite and posterior crossbite. Abnormal tongue posture and tongue thrust swallow result in proclination of maxillary anterior teeth and openbite. Mouth breathing causes incompetence of lips, lowered position of tongue and clockwise rotation of the mandible. Early diagnosis and treatment of the orofacial myofunctional disorders render great benefits by minimizing related malocclusion and reducing possibility of relapse after orthodontic treatment. Myofunctional appliances or pre orthodontic trainers are new types of prefabricated removable functional appliances claimed to train the orofacial musculature; thereby correcting malocclusion. This review aimed to search literature for studies and case reports on effectiveness of pre-orthodontic trainers on early correction of developing malocclusion. Current literature renders sufficient evidence that these appliances are successful in treating Class II malocclusions especially those due to mandibular retrusion. Case reports on Class I malocclusion have reported alleviation of anterior crowding, alignment of incisors and correction of deep bite with pre-orthodontic trainers. Most promising results with pre-orthodontic trainers are seen in improved nasal breathing, improved swallowing pattern and elimination of habits like tongue thrusting and mouth breathing. Keywords: Pre-orthodontic trainers, Myofunctional appliances, Early orthodontic treatment, Oral habits correction, Prefabricated functional appliance ----------------------------------------------------------------------------------------------------------------------------- ---------- Date of Submission: 10-04-2019 Date of acceptance: 26-04-2019 --------------------------------------------------------------------------------------------------------------------------------------------------- I. Introduction Evidence suggests that malocclusion poses a great burden worldwide with its prevalence in India ranging from 20% to 41%.[1,2] Orthodontic treatment is required for correction of malocclusion but relapse of malocclusion occurs if any aberrant muscle activity is ignored. Relapse is a dento-alveolar and skeletal change after orthodontic treatment towards the initial malocclusion.[3] Retraining the abnormal muscle tone and function, along with correction of the dento-alveolar system is necessary, in order to avoid the risk of relapse and to attain stable orthodontic results. Functional appliances offer much benefit as they help in eliminating oral dysfunction by establishing muscular balance and allowing proper growth and development of the jaws. Pre-orthodontic trainers or the myofunctional trainers are new types of prefabricated removable functional appliances which according to the manufacturer‘s claims, train and exercise the orofacial muscles into their correct position and bring about a state of equilibrium between the forces delivered onto the dento-alveolar system, helping in alignment of the teeth and stimulating proper growth and development of the craniofacial system. This review aims to present the abnormalities in muscle functions associated with deleterious oral habits in children and effectiveness of pre-orthodontic trainers in the treatment of malocclusions caused by such aberrant muscle functions. II. Disorders of or facial musculature Orofacial muscles work in harmony during any oral function like mastication, deglutition, speech, and affect the shape of the arches and position of the teeth.[4] Any alteration in the activity of these muscles can compromise the orofacial morphology, functioning, well-being and oral health-related quality of life from childhood.[5] One of the main functional factors of orofacial dysfunction is the presence of oral habits that influence the development of malocclusion.[4,6,7] Oral habits are repetitive behavior in the oral cavity that result in loss of tooth structure, effect of which is dependent on the nature, onset and duration of these habits.[7,8] DOI: 10.9790/0853-1804172228 www.iosrjournals.org 22 | Page Current evidence on the Effect of Pre-orthodontic Trainer in the Early Treatment of Malocclusion 2.1 Effects of oral habits on orofacial musculature 2.1.1. Non-nutritive sucking Nonnutritive sucking habits are associated with an atypical swallowing pattern and tongue thrust swallow. Persistent non-nutritive sucking habit in children is shown to cause anterior open bite and posterior crossbite in mixed as well as primary dentition.[9,10,11,12,13,14,15,16] Pacifier sucking and bottle sucking frequently cause protrusion of the upper incisors and the premaxilla, atypical swallowing, anterior open bite and posterior crossbite. Vacuum sucking movements occur with the tongue, lips and the cheek as the tongue presses the nipple against the palate, also generating a high palate and crossing the bite in the posterior region.[17,18] Posterior crossbite is because of this low positioning of the tongue during sucking, along with lack of thrust of the tongue on the palate and increased activity of the muscles of the cheeks that alters the pressure applied by the muscle on the maxillary arch.[8] Such type of sucking jeopardizes the motor development, the position and the strength of the stomatognathic structures.[17] In case of finger sucking, there is increased pressure from the buccinators to facilitate sucking. Because of presence of a digit in the mouth during sucking, the tongue assumes a lower position. The increased buccinator activity along with absence of tongue pressure and the positioning of the digit into the oral cavity brings about narrowing of the upper arch and protrusion of the anterior teeth. There is increased contraction of the mentalis muscle which contributes to increased overjet. Patients presenting with both, contraction of mentalis muscle and increased overjet, show a tendency for the lower lip to be pushed behind the upper incisors, preventing the reduction of the overjet or interfering in the retention.[19] Children with pacifier or digit-sucking habits may also demonstrate tongue thrusting activity and/or altered lip-to-tongue resting positions. The depth to which the digit is inserted in the oral cavity affects the lip- to-tongue resting position and also accordingly alters the pressures applied by the muscular walls of the oral cavity.[20] 2.1.2. Tongue thrust Abnormal tongue posture is seen in children with tongue thrust habit wherein the tongue is placed at a forward position between the teeth and against the lower lip while swallowing, in order to obtain a lip seal, disturbing the equilibrium between the forces exerted upon the teeth.[20,21] Tongue thrust causes proclination of the maxillary anterior teeth, which may result into increased overjet, midline diastema and also sometimes bimaxillary protrusion.[22,23] The low positioning of the tongue causes lack of thrust on the palate and increased activity of the muscles of the cheeks resulting into an alteration of muscle pressure on the maxillary arch preventing transverse and anterior development of the maxilla,[8,24] leading to unilateral or bilateral posterior crossbite.[25] Lisping or impaired speech might also be observed in some cases.[26] Tongue thrust habit can also be the primary cause of open bite, especially when accompanied with mouth breathing.[8,22] 2.1.3. Mouth breathing Mouth breathing causes incompetence of lips, lowered position of tongue and increased vertical height of the face due to clockwise rotation of the mandible.[8] Typical facial features in mouth breathers include presence of long face, narrow nostrils, maxillary constriction at the level of canines, high arched palate and gummy smile associated with malocclusion of class II or, sometimes, class III, with a high prevalence of posterior crossbite and anterior openbite.[8,21,27] Narrowing of the maxilla and the palate is as a result of insufficient support from the tongue due to its lowered posture. In such cases, the upper lip is generally short and functionless resulting in proclination of maxillary incisors; while the lower lip is large and bulbous, trapped behind proclined maxillary incisors. This constant pressure increases the overjet.8 Constant open jaw and lack of thrust due to low posture of the tongue may also cause a sagittal and transverse maxillary skeletal deficit. There is constant distraction of the mandibular condyle from the fossa which may act as a growth stimulus for excessive mandibular growth. This contributes the role of mouth breathing in some forms of Class III malocclusion.[8,28] Early diagnosis and treatment of the orofacial myofunctional disorders render great benefits by minimizing related malocclusion and reducing possibility of relapse after orthodontic treatment. III. Pre-orthodontic trainers
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